Is Adrenal Fatigue Real?

“Adrenal fatigue” is a term that has been widely used in alternative and functional medicine circles for years. It describes a collection of symptoms—such as chronic fatigue, brain fog, irritability, sleep disturbances, and sugar cravings—that many people experience due to prolonged stress. But is adrenal fatigue a real medical diagnosis, or is there a more accurate way to describe what’s happening in the body? Let’s dive into the science and uncover the truth behind this controversial topic. 

The Myth of Adrenal Fatigue 

The concept of adrenal fatigue suggests that chronic stress overworks the adrenal glands, causing them to become “exhausted” and unable to produce sufficient cortisol. However, conventional medicine largely rejects this idea, citing a lack of scientific evidence. The Endocrine Society and other medical organizations state that while true adrenal insufficiency—such as Addison’s disease—is well-documented, the notion that the adrenal glands simply “burn out” from chronic stress is not supported by research (Marik, 2020). 

In reality, most people experiencing symptoms attributed to adrenal fatigue do not have malfunctioning adrenal glands. Instead, they are likely dealing with what is more accurately termed Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction—a condition that results from prolonged stress disrupting the brain’s communication with the adrenal glands. 

HPA Axis Dysfunction: The Real Culprit 

The HPA axis is the body’s central stress response system, involving the hypothalamus (H), pituitary gland (P), and adrenal glands (A). This intricate feedback loop regulates cortisol production in response to stress. When it’s working well, the HPA axis ensures that cortisol levels rise and fall appropriately throughout the day. However, chronic stress can dysregulate this system, leading to inconsistent or blunted cortisol production—not because the adrenal glands are “fatigued,” but because the brain is sending mixed signals (Chrousos, 2009). 

Research suggests that chronic stress leads to desensitization of the HPA axis, similar to insulin resistance. Instead of producing consistent levels of cortisol, some people experience an irregular rhythm, with either elevated or suppressed cortisol at the wrong times (Foster et al., 2019). This miscommunication contributes to the fatigue, mood swings, and metabolic issues often blamed on adrenal fatigue. And this is no fun! But fortunately, it’s fixable. 

How to Heal HPA Axis Dysfunction  

If you’re experiencing symptoms associated with adrenal fatigue, the key to healing lies in rebalancing the HPA axis, rather than focusing solely on adrenal support. Here are some evidence-based strategies to restore proper function: 

GO TO BED (and calm your nervous system)  

Sleep is one of the most powerful tools for HPA axis recovery. Aim for 7-9 hours of quality sleep per night, and maintain a consistent sleep-wake schedule. Practices like meditation, deep breathing, and yoga have been shown to lower cortisol and improve HPA axis function (Pascoe et al., 2017). 

Balance Blood Sugar

Dysregulated blood sugar contributes to HPA axis dysfunction by causing frequent cortisol spikes. Protein, healthy fat and fiber are your friends when it comes to keep blood sugar stable. Stay away from refined carbs like sugar and ultra-processed foods that can cause blood sugar spikes.  

Manage Stress Effectively 

Chronic psychological stress is a major driver of HPA axis dysfunction. Implementing stress management techniques—such as journaling, spending time in nature, or seeking therapy—can improve resilience and restore cortisol regulation (McEwen, 2012). 

Incorporate Adaptogenic Herbs

Herbs like ashwagandha, rhodiola, and holy basil have been shown to support HPA axis regulation and improve stress resilience. Ashwagandha, in particular, has been found to lower cortisol levels in individuals experiencing chronic stress (Chandrasekhar et al., 2012). 

Exercise Smartly

While exercise is beneficial for HPA axis balance, too much high-intensity training can worsen dysfunction. Moderate-intensity activities like walking, strength training, and restorative yoga help support recovery without overloading the system. How do you know if you’re doing too much? If your workouts leave you wiped out for the rest of the day, it’s probably too much. And there is absolutely no shame in backing off if you need it! 

Optimize Nutrient Intake

Nutritional deficiencies can make HPA axis dysfunction worse. Key nutrients such as magnesium, vitamin C, B vitamins, and omega-3 fatty acids play vital roles in stress regulation. If you’re eating a well-balanced diet, you may be getting enough, but consider supplementing if needed (Song et al., 2022).

Get Comprehensive Testing

If you suspect HPA axis dysfunction, working with a healthcare provider to assess cortisol levels through saliva, urine, or blood testing can provide insights into your stress response patterns. The DUTCH test is my preferred way to evaluate cortisol rhythms and guide personalized interventions. 

The Bottom Line 

HPA axis dysfunction can negatively impact longevity by increasing the risk of chronic diseases, accelerating aging, and impairing the body’s ability to cope with stress, leading to potentially shorter lifespans. While “adrenal fatigue” may not be a scientifically validated term, the symptoms people describe are very real. Instead of attributing these issues to adrenal exhaustion, it is more accurate to recognize HPA Axis Dysfunction as the underlying cause. By focusing on stress management, sleep, nutrition, and lifestyle adjustments, individuals can restore balance to their stress response system and reclaim their energy and well-being. 

If you’ve been struggling with unexplained fatigue, burnout, or hormonal imbalances, let’s talk. Addressing your HPA axis health is a crucial step toward long-term health and vitality. 

References 

• Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of Ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255–262. https://doi.org/10.4103/0253-7176.106022 
• Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5(7), 374–381. https://doi.org/10.1038/nrendo.2009.106 
• Foster, M. T., Hilderbrand, T., & Cain, D. W. (2019). The impact of chronic stress on the HPA axis: An immunometabolic perspective. Frontiers in Immunology, 10, 469. https://doi.org/10.3389/fimmu.2019.00469 
• Marik, P. E. (2020). Adrenal fatigue does not exist: A systematic review. Journal of Intensive Care Medicine, 35(4), 441-451. https://doi.org/10.1177/0885066618790877 
• McEwen, B. S. (2012). Brain on stress: How the social environment gets under the skin. Proceedings of the National Academy of Sciences, 109(2), 17180-17185. https://doi.org/10.1073/pnas.1121254109 
• Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Yoga, mindfulness-based stress reduction and stress-related physiological measures. Psychoneuroendocrinology, 86, 152–168. https://doi.org/10.1016/j.psyneuen.2017.08.008 
• Song, H. J., et al. (2022). Role of dietary nutrients in HPA axis regulation. Nutrients, 14(1), 125. https://doi.org/10.3390/nu14010125